May 31, 2008

NST: KUALA TERENGGANU: They are an unusual looking lot of paramedics with their cycling helmets, elbow pads and bicycles.
But the additions that seem out of place are integral to their duties at the 12th Sukan Malaysia (Sukma) games here.
The equipment is to aid the four paramedics — members of a mobile clinic — race to the scene of injuries during the games, which began yesterday and end on June 9.
The team is said to be the second of its kind to be formed in the country. The first bicycle team was formed at Kuala Lumpur Hospital two years ago.
Comprising staff of Sultanah Nur Zahirah Hospital here, they will be the first to respond to medical emergencies and also be responsible for medical surveillance.
State Health director Dr Nordiyanah Hassan said the team would remain after Sukma for other events like the Monsoon Cup or the World Endurance Championship later this year.
“The paramedics will be able to manoeuvre better through crowds on their mountain bikes and go to places an ambulance can’t reach.
“Getting to a scene as soon as possible can make a lot of difference,” she said after launching the team at the Sultan Mizan Zainal Abidin stadium.
She said the number of paramedics involved might be increased, depending on the need.
Dr Nordiyanah said paramedics on bicycles had proven effective in countries like Britain and Australia.
The mountain bikes are equipped with, among others, an automated external defibrillator, respiratory equipment and drugs.

Star: MIRI: The Health Ministry has reactivated the “flying doctor” service in Sarawak’s vast interior areas.
The unique service was suspended early last year due to technical issues faced by aviation company Hornbill Skyways which had been operating it for decades.
The ministry recently issued a directive to urgently resume the daily flying doctor programme following constant appeals from rural folk who had been adversely affected by the suspension.
However, the ministry has now divided the state into two zones – southern Sarawak (Kuching and Sri Aman divisions) and northern Sarawak (Kapit, Miri and Limbang divisions).
The southern zone will be under Hornbill, while another aviation company, Layang-Layang, will handle the northern zone.
Sarawak Health and Medical Services director Dr Zulkifli Jantan said the two companies had been given six-month contracts to operate the flying doctor service.
“For the time being, the service will be via a short-term contract arrangement. We (ministry) have long-term plans to open up the flying doctor programme to an open tender system.
“Through this tender system, we hope to appoint only one contractor to handle the whole state, but that contractor must be able to meet our stringent requirements.
“One of the most important requirements is that the company must be able to provide twin-engine helicopters daily without any interruption,” Dr Zulkifli told The Star.
He said other companies wishing to operate the service must “fly as and when they were needed” as medical help must reach remote areas.
“The flying doctor must operate every day and when there are emergency cases, instant service must be activated,” he said.
He said the ministry hoped to sort out the open tender arrangement by end of the year.

May 29, 2008

NST: KUALA LUMPUR: Form Four students will soon have to undergo screening for thalassaemia.
The screening, which is to be carried out in phases, is intended to detect carriers of this genetic disease.
They will be counselled against marrying another carrier to avoid producing children with thalassaemia major.
There are 3,591 Malaysians with thalassaemia major. The government is spending some RM29.5 million annually on their treatment, which includes blood transfusion, iron chelation therapy and medication for complications arising from the disease.
The government spends almost RM20 million to buy medical equipment for these patients.
Health Minister Datuk Liow Tiong Lai said it was important to carry out screening because it would help to reduce the incidence of thalassaemia major in the country and achieve the target of zero patients by 2025.
In Malaysia, it is estimated that one in 20 people are carriers.
“Our focus is basically to screen those between the ages of 16 and 24.
“The public can also go for screening at designated clinics and hospitals,” he said at the launch of World Thalassaemia Day at Berjaya Times Square yesterday.
There are 242 health clinics and eight hospitals which are equipped with haematology analysers.
The eight hospitals are also equipped with high performance liquid chromatography and gel electrophoresis to conduct screenings.
Liow said a National Thalassaemia Registry was established last year to ascertain the actual number of thalassaemia major patients in the country.
“Treatment for these patients is free at government hospitals.
“The survival rate for the victims has increased with some having lived beyond the age of 35.”
With proper treatment and medication some patients have lived to take up professional careers.
The Thalassaemia Day event was organised by the ministry, UKM Medical Molecular Biology Institute, Malaysian Society of Paediatric Haematology and Oncology and Federation of Malaysian Thalassaemia Societies.
Health Ministry deputy director-general Datuk Dr Ramlee Rahmat said health teams would go into schools and talk to students about thalassaemia and urge them to go for checks at designated health clinics and hospitals.
Dr Ramlee said if measures were not taken to reduce the incidence of thalassaemia major, the government would have to allocate an exorbitant sum for the management and treatment of the disease. It costs between RM25,000 and RM35,000 to treat a patient annually.
According to World Health Organisation statistics, some 300,000 children are born every year with red blood cell genetic disorders known as haemoglobinopathy and of that number, some 70,000 are thalassaemia patients.
Dr Hishamshah Mohd Ibrahim of Kuala Lumpur Hospital’s Paediatric Institute warned the public that traditional medicine cannot cure the disease.

NST: KUALA LUMPUR: Doctors have come out in support of the Health Ministry’s proposal to refer patients with chronic ailments at government hospitals to private clinics.
The Malaysian Medical Association (MMA) said this would ensure that patients with these kind of diseases would receive treatment at these clinics after office hours.
“Many chronic patients are working and cannot afford to make time to go to government hospitals which are only open during office hours,” said MMA president Datuk Dr Khoo Kah Lin.
He said, with the legalities and procedures ironed out, this could turn out to be an example of good partnership between the government and the private sector.
“Everyone knows that government hospitals are overloaded and doctors in the private sector, especially those registered with the Malaysian Medical Council, are more than happy to help out.”
However, he stressed the need for fool-proof guidelines on the funding of the programme and the kind of treatment private clinic doctors would be allowed to provide.
“The prescription of medicine has to be thought out clearly.
“I am sure the government would want to encourage the use of basic generic drugs. But there will be situations where special one-of-a-kind drugs will be required.”
The Federation of Private Medical Practitioners’ Association said the treatment had to be financed by a national healthcare fund.
Association president Dr Steven Chow said the public was already paying for the bulk of the fees under the existing system.
“What we are advocating for is to allow the private sector to help provide a more cost-efficient system.”
He said there should be mechanisms to ensure quality medical care and protection of patients’ rights.
This was echoed by National Consumer Complaints Centre director Darshan Singh who urged checks and balances to prevent abuse.
“There may be unscrupulous government hospital doctors who will refer these patients to their friends in the private sector and then split the profits.
“Even worse, they may start referring patients to private clinics even if the patients does not need follow-up treatment in the first place.”

May 28, 2008

NST: KUALA LUMPUR: Malaysia is showing its support for stem cell research by approving a RM32 million allocation to develop and strengthen stem cell and cord blood banking activities in the country.
Health Minister Datuk Liow Tiong Lai said RM5.86 million was for the setting up of a stem cell transplantation laboratory at Institute for Medical Research, while RM18.87 million was for the expansion of the public cord blood banking facility at the National Blood Bank and Sultan Abdul Halim hospital in Sungai Petani.
Another RM5.57 million is to strengthen stem cell and bone marrow transplantation services at Ampang hospital.
Liow, however, warned that stem cell research and treatment must be within the agreed ethical guidelines.
He said clinical use of embryonic stem cells was not permitted, while all forms of experimental stem cell therapies for myocardial infarction, spinal cord injuries, Down’s Syndrome and cerebral palsy must be approved by the Institute’s Research and Ethics Committee.
To further protect potential patients, Liow said the development and application of new, innovative and investigational cell therapy was also subject to the approval of the ministry.
A National Stem Cell Committee has also been formed to provide governance and leadership.
“It will develop and support organ, tissue and cell transplantation units in designated hospitals, work with the relevant agencies to ensure that institutions are accredited and practitioners are credentialled,” he said.
The committee which reports to the National Transplantation Council, chaired by the director-general of health, is the main governing body of the transplantation programme.
Liow was speaking yesterday after attending a briefing on the status of stem cell therapeutics in Malaysia at Wisma Perintis.

NST: KUALA LUMPUR: The National Service Training Department has been instructed to adopt a “better safe than sorry” approach on sick trainees.
Camp commandants had been told to take all ill trainees to hospital, regardless of how minor or trivial their complaint might seem, Deputy Prime Minister Datuk Seri Najib Razak said.
Najib briefed the 85 commandants from around the country on the new approach at a meeting yesterday.
Also in attendance were department director-general Datuk Abdul Hadi Awang Kechil, National Service Training Council chairman Tan Sri Lee Lam Thye and the military service chiefs.
Najib said the national service programme was sensitive because parents were placing their trust in the government to take good care of their children.
“If they get sick, they must be taken to the hospital as soon as possible. It’s okay even if it is just a minor problem like a fever as it is better to be safe than sorry.”
He said there was no change in policy per se, but that camp authorities needed to be more proactive in carrying out their duties.
He said the government was driving for zero deaths in the programme.
“Although not all deaths were caused by problems in the camp as there were those who died during holidays and those who had illnesses before going to the camp, there’s no denying that there have been a few incidents that could have been avoided.”

NST: KUALA LUMPUR: Of the 3,000 thalassaemia major sufferers in Malaysia, only around 100 have been lucky enough to undergo the bone marrow transplant procedure necessary to cure their illness.
In each case, fully-compatible donors were found from within the patient’s family.
Thalassaemia Society of University Hospital president Professor Dr Chan Lee Lee said most of the donors were siblings of the thalasemic patient.
In fact, on average, one in four of a thalasemic’s siblings is a suitable donor. Parents and unrelated people are very rarely a close enough match.
Dr Chan said only three hospitals in Malaysia can perform the bone marrow transplant procedure: Kuala Lumpur Hospital (HKL), University Malaya Medical Centre (UMMC) and Subang Jaya Medical Centre (SJMC).
“A patient who is to undergo the procedure is admitted (to these hospitals) for at least two to three months. A series of tests is done before the marrow is taken from the donor.”
The marrow is extracted from bone that is rich in it, such as the hip bone, using a syringe.
Once that is completed, space must be made in the thalasemic patient’s bones before the marrow is transplanted. This is done by placing the marrow in a blood bag and running it into a vein, just like with a blood transfusion.
Dr Chan said the procedure is quite expensive, costing about RM150,000 if conducted at UMMC, and RM500,000 if done at SJMC.
For patients unable to locate a compatible donor within the family, some embark on searching for non-related donors, which is very difficult and rare.
Dr Chan said the 3,000 thalassaemia major patients in Malaysia were still on regular blood transfusion and iron chelation therapy.
She said 97 of these patients had been undergoing oral chelation therapy since 2006, when the pharmaceutical company responsible for manufacturing the drug took in the patients for its clinical trials. The company was still supporting these patients by providing the drug for free.
Dr Chan said she hoped the government would also provide the oral chelation therapy drug so that patients need not undergo the agony of other painful therapies, which included injecting drugs into the bloodstream five times a week for up to 12 hours each time.
One thalassaemia major victim who is now leading a normal life after a bone marrow transplant is Nik Ahmad Hashimi, 8. His donor was none other than his younger brother, Nik Abdullah Ariff, 4.
Nik Ahmad Hashimi was diagnosed with thalassaemia major when he was 21 months old and had the transplant in 2006 at HKL.
His mother, 45-year-old accounts executive Nik Rosenidah Jaafar, said Nik Ahmad Hashimi “came down with fever too often, vomited whatever he ate and he looked yellowish”.
He was diagnosed at Universiti Kebangsaan Malaysia Hospital.
“The whole family was screened and all of us were found to be carriers, except for my eldest son,” she said. She has four sons and a daughter, aged six to 15.
Nik Ahmad Hashimi began receiving blood transfusions in 2002, and in 2005, he began chelation therapy when he was found to have “iron overloading” – a common side effect of the body not being able to remove the build-up of iron naturally.
In August 2006, it was found that younger brother Nik Abdullah Ariff’s bone marrow was a compatible match, and the next month he had the transplant.
Nik Rosenidah said neither she nor her husband had known that they were carriers of the disease until Nik Ahmad Hashimi fell ill.
“I felt so sorry for causing my son to suffer. I kept apologising to him every time I saw him in pain. I definitely would not have conceived if I had known both my husband and I were carriers.”
She said the two boys had developed a close bond and they were even starting to look like each other.
“Many people have asked if they are twins. They look so much alike. Even I am surprised at the change,” said the relieved mother.

NST: KUALA LUMPUR: Patients with chronic diseases currently being treated at government hospitals may be referred to private clinics.
This is to cut down the patient load in public hospitals besides making it easier for them to obtain treatment nearer their homes.
Health Minister Datuk Liow Tiong Lai said this was only for those with problems like diabetes which needed regular consultation with a doctor.
“It is for those who need to see the doctor and get medication regularly,” he said after witnessing the signing of a Memorandum of Co-operation between Kojadi Institut and Ikram Skills and Retraining Company and ABS Consulting (M) Sdn Bhd.
He also launched a welding course for Kojadi.
Liow said the idea was still under study with the ministry working out a payment scheme for consultation and medication prescribed by the clinics.
It is learnt that the move, if implemented, would be financed by the National Healthcare Financing Scheme with co-operation from Pharmaniaga, a local healthcare company.
This is among ministry strategies to cope with an overload of patients and shortage of staff at public hospitals.
The doctor-patient ratio in Malaysia is 1:1,200 whereas the ideal position is 1:600.
“We have also started getting doctors from private clinics and hospitals to serve in government hospitals for a small fee,” Liow said.
Liow said the number of doctors doing this as “national service” had been encouraging with participants receiving RM80 per hour for their services.
The government is still finding ways to iron out kinks including insurance for participating doctors. A ministry source said the rates should attract doctors who earned an average of RM50 an hour as locums at private clinics.
Liow said he had issued a directive to government doctors to adopt “patient ownership” with one doctor responsible for an in-patient.
“We are starting off by putting names of doctors above patients’ beds. That way, patients can also be comforted knowing who their doctors are.”

Star: KUALA LUMPUR: Private clinics may soon be roped in to help the Health Ministry ease its patient load.
Minister Datuk Liow Tiong Lai said that if implemented, patients with chronic ailments would be sent to the clinics for follow-up treatment and medication.
He said the Government would pay for the consultation fees and medication of patients referred to private clinics.
“It is being studied. I have asked the (Health) Director-General to see how we can do it. This will be for those with chronic diseases like diabetes,” Liow told reporters yesterday, after witnessing the signing of a memorandum of co-operation between Kojadi Institute, Ikram Skills and Retraining Academy and ABS Consulting.
“This is because they need to see the doctor every one or two months, when they can get their medication. The doctors will also give them a check-up.”
Liow also said that doctors at government hospitals, who were on call, were now allowed to be off the next day. He said this was to further decrease the possibility of medical negligence.
“I want them to be at their fittest and not have problems handling patients,” he said.
Liow also urged more private sector doctors to volunteer their time at government medical establishments at least once a month.
“It is national service and we pay a token fee of RM80 an hour,” he said.
He added the ministry was still working out logistics such as office space to accommodate the private sector doctors.
Liow said as of two weeks ago, doctors at government hospitals were required to place their names at the beds of patients to create a “patient ownership” environment.
“This is so that the patient will know the doctor in charge. It does not matter if the system at government hospitals has doctors treating patients on a rotation basis.” he added that the “primary” doctors would place their names at the hospital beds.
Liow also said the ministry was willing to consider applications from companies wishing to start cord blood banks.
“Currently, four have registered with the ministry,” he said.
He added that government doctors had been sent for overseas training to enable them to operate cord blood banks.

Star: PETALING JAYA: The Malaysian Medical Association (MMA) is demanding a full clarification over Deputy Health Minister Datuk Dr Abdul Latiff Ahmad’s statement that doctors were “licensed to kill”.
“We are not sure in what circumstances this word ‘to kill’ was used and as such a full clarification would be helpful,” its president Datuk Dr Khoo Kah Lin said in a statement yesterday.
He said the association wanted to impress on the public that doctors were only licensed to heal and supported patients by helping to ease suffering due to illnesses.
Any death, which happened during the course of treatment, was due to the severity of the disease, he said.
“Any negligent cause of death during treatment is answerable. This is to reassure the public that neither the Malaysian Medical Council nor the MMA condones the notion that doctors are licensed to kill at any point in time,” he added.
It was reported that Dr Abdul Latiff had in the Dewan Rakyat on Monday wanted to adopt the James Bond movie Licence to Kill when replying to a supplementary question by Alexander Nanta Linggi (BN – Kapit) during Question Time.
Dr Abdul Latiff said doctors were given the “licence to heal” as well as the “licence to kill.”
He later retracted his statement but said he would not apologise.
Dr Khoo said the association was shocked to read about the remark uttered by Dr Abdul Latiff, adding it was unfortunate that he had “blurted out such a remark.”
Health Minister Datuk Liow Tiong Lai, when asked by reporters yesterday, said he had the highest regard for doctors.
He said it was an ethical profession where the doctors “had the heart” to save lives.
“And the ministry has always ensured that negligence is minimal,” he said after witnessing the signing of a memorandum of cooperation between Kojadi Institute, Ikram Skills and Retraining Academy and ABS Consulting.